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Korean J Crit Care Med > Volume 26(2); 2011 > Article
Korean Journal of Critical Care Medicine 2011;26(2): 83-88. doi: https://doi.org/10.4266/kjccm.2011.26.2.83
기계호흡 중인 중증폐렴에서 기관지내시경 검체와 경기관지흡인 검체간의 일치성 및 임상적 의의
박혜성ㆍ김서우ㆍ심윤수ㆍ김지혜ㆍ류연주ㆍ이진화ㆍ장중현
이화여자대학교 의학전문대학원 내과학교실
The Consistency and Clinical Significance between Bronchoscopic Samples and Endotracheal or Tracheostomic Aspirates in Severe Pneumonia Under Mechanical Ventilation
Hye Sung Park, Seo Woo Kim, Yun Su Sim, Ji Hye Kim, Yon Ju Ryu, Jin Hwa Lee, Jung Hyun Chang
Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea. hs1017@ewha.ac.kr
ABSTRACT
BACKGROUND: Distal airway bacterial colonization occurs more frequently in patients with endotracheal tubes or tracheostomy of intensive care units (ICU) care. In general, bronchoscopic samples are considered more accurate than transtracheal aspirates. In this study, we evaluated the consistency and clinical significance between bronchoscopic samples and transtracheal aspirates (TTA) in severe pneumonia under mechanical ventilation. METHODS: We investigated the consistency between bronchoscopic samples and transtracheal aspirates among patients with endotracheal tubes or tracheostomy, retrospectively. Fiberoptic bronchoscopy was performed in 212 patients with mechanical ventilation via endotracheal tube or tracheostomy between January 1st, 2004 and December 31th, 2008 in ICU at Ewha Womans University Hospital. We evaluated consistency in terms of true pathogen according to the arbitrary ICU days progress. RESULTS: Among the 212 enrolled patients, 113 (53%) had consistency between bronchoscopic samples and transtracheal aspirates. When evaluated alteration trends in consistency according to ICU stay, the consistency was maintained for 5 to 9 ICU days with statistical significance (p< 0.05) since adjusting for age, sex, and combined risk factors. Consistency in sampling status between the endotracheal tube and tracheostomy was also evaluated, however, there was no statistical significance (OR 1.9 vs. 1, 95% CI = 0.997-3.582, p = 0.051). CONCLUSIONS: Shorter hospital stay (within 9 days of ICU stay) had higher probability of consistency between bronchoscopic samples and TTA samples. TTA may be as confident as bronchoscopic samples in patients of pneumonia under mechanical ventilation with shorter ICU stays, especially less than 10 days.
Key Words: bronchoscopic; endotracheal aspirates; mechanical ventilation; pneumonia
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